Missouri lawmakers propose restoring caps on medical malpractice payouts

Posted February 28, 2013 at 11:09 am

by Josie Butler

The Senate Judiciary Committee was warned Monday, Feb. 4, that physicians will leave the state, leading to less quality care, if a cap on medical malpractice payouts is not implemented.

Sen. Dan Brown, R-Rolla, has sponsored a bill that would place a cap of $350,000 for non-economic damages in medical malpractice lawsuits. Non-economic damages are defined as pain and suffering, emotional damage and companionship.

The Missouri Constitution follows English common law from 1607 on issues not covered by Missouri law. The cap on noneconomic damages was ruled unconstitutional by the Missouri Supreme Court because English common law prohibits caps. Brown said his bill would solve this problem because it would exempt this issue.

He also said he believes his bill will prevent Missouri from losing physicians to other states that do have caps on medical malpractice claims.

“We were losing a lot of good physicians in Missouri,” Brown said. “We were losing a lot of specialty practices because the risk of a neurosurgeon or someone who delivers babies is much greater than a general practitioner and therefore those folks were choosing not to come to Missouri. Once we put the caps on we grew by 1,000 physicians in a very short period of time.”

Ken Vuylsteke, vice president of the Missouri Association of Trial Attorneys, said he opposes the cap. Vuylsteke said he represents the future medical malpractice victims of Missouri.

“It would allow caps to be introduced on cases where people have been crippled for life, blinded, they are brain damaged and have to live with that for the rest of their lives,” Vuylsteke said.

be distributed to the Assessor in November 2012. The amounts due the Assessment Fund were calculated by the State Auditor’s office and were found correct.

2.2. To ensure the Collector’s commission and Assessor’s fee on the Railroad and Utility Funds are disbursed correctly, I have discussed this with the programmer and input those fees into the spreadsheet I currently use. The Railroad and Utility disbursements will be corrected for past years in November or December of 2012. The amounts due were calculated by the State Auditor’s office and were found correct.

2.3. The programmer has implemented a report that will be available for checking and controlling transaction numbers for all transactions done in the office. Also, better security has now been implemented over computerized transaction numbers.

Prosecuting Attorney’s Controls and Procedures

As noted in our prior audit report, accounting duties are not adequately segregated, and a documented supervisory review is not performed. Receipts are not always deposited timely, and manual receipt slips issued are not reconciled with monies posted to the computerized accounting system to ensure all monies received are properly recorded and deposited. The Prosecuting Attorney’s Office does not always disburse restitution payments in accordance with the court’s instructions, and some payments were made to different victims than noted in court records.


The Prosecuting Attorney:

3.1 Adequately segregate accounting duties to the extent possible or ensure supervisory reviews of accounting records are performed and documented. Additionally, the Prosecuting Attorney should require a supervisory review and approval for all accounting adjustments.

3.2 Deposit all monies in a timely manner and reconcile manual receipt slips issued to the computerized accounting system.

3.3 Compare restitution case files with those maintained by the Circuit Court and resolve any differences.

Auditee’s Response

The Prosecuting Attorney provided the following written responses:

3.1 The Prosecuting Attorney has reviewed the bank statements each month. Since the audit has brought into question documentation of this review, the Prosecuting Attorney has been documenting his review by initialing and dating the reconciliation/review.

Only the Prosecuting Attorney has authority to disburse funds from the restitution trust account. Due to limited staffing, further segregation of documented duties is not possible at this time. However, documented supervisory review of other accounting records, including a documented review of adjustments made to the computer system will be accomplished in the future.

3.2 Cash is not collected in our office; however, the office is implementing measures to ensure deposits are made in a timelier manner. Also, one of the other full-time employees will be involved in the depositing procedures including the reconciling of the manual receipt slips to monies posted to the system.

3.3 We are aware that due to a defendant owing money in multiple cases these monies were disbursed incorrectly in at least one criminal case. We are working with the court to correct the situation. No money has been disbursed to those not owed restitution.

Sheriff’s Controls and Procedures

Accounting duties are not adequately segregated, and receipting and depositing procedures need improvement. The numerical sequence of receipt slip numbers is not accounted for properly, receipts are not reconciled to deposits, the method of payment is not always recorded, and monies are not always deposited timely. Monthly bank reconciliations have not been performed since June 2011, and liabilities are not identified and reconciled to the cash balance each month. Deposits are not recorded in the check register and a running cash balance is not maintained, so disbursement errors were not identified, and some bond receipts were not disbursed in a timely manner.


The Sheriff:

4.1 Adequately segregate accounting duties to the extent possible or ensure independent or supervisory reviews of accounting records are performed and documented.

4.2 Account for the numerical sequence of receipt slip numbers, retain all copies of voided receipt slips, record the composition of receipts and reconcile to deposits, and deposit all monies timely and issue checks to the court for bonds or obtain receipt slips from the court for bond monies transmitted.

4.3 Maintain a running cash balance, prepare monthly bank reconciliations, identify liabilities and reconcile to the cash balance, and retain all bank statements.

Auditee’s Response

The Sheriff provided the following written responses:

4.1 I am now reviewing the accounting records prepared by the office manager.

4.2 & 4.3 These recommendations have been implemented.

Sunshine Law

The county did not always document the vote for closing the meeting or cite the specific statute and subsection allowing the closure, and some topics discussed in closed meetings were not allowable.


The County Commission should ensure open meeting minutes document the reason and the corresponding vote for entering closed session and ensure items discussed in closed meetings comply with the Sunshine Law.

Auditee’s Response

The County Commission provided the following written response:

Meetings minutes now include reasons and corresponding votes for entering closed session. We believe we have complied with the Sunshine Law, but in the future, we will better document this.

Findings in the audit of Cedar County

Additional Comments

Because counties are managed by several separately-elected individuals, an audit finding made with respect to one office does not necessarily apply to the operations in another office. The overall rating assigned to the county is intended to reflect the performance of the county as a whole. It does not indicate the performance of any one elected official or county office.